Transcript Technology’s role in maintaining healthy life styles

Technology’s role in reaching and
maintaining healthy life styles
Remarks for the meeting of the Dutch Ministry of
Health, Welfare and Sport, November,13,2007
Technische Universiteit Eindhoven
James L. Fozard, Ph.D.
University of South Florida
Tampa, FL 33618 USA
My second interaction with the
Dutch Ministry of Health, Welfare
and Sport
• In 1996, A symposium, “Problems and solutions
in longitudinal research” was held in honor of the
20th anniversary of the Amsterdam Growth and
Health Longitudinal Study
• Opening address by Secy Erica Terpstra
• I served as one of the two peer reviewers for the
13 invited papers published in the International
Journal of Sports Medicine, July 1997, 18,
Suppl 3, S139-S254
Importance of Healthy lifestyle
begins early in life
• Lessons from many longitudinal studies of
growing children—especially teenagers—
show a strong relationship between
healthy lifestyles with respect to
cardiovascular risk factors observed in
young adulthood
• Two examples follow
– The Bogalusa Heart Study
– The Amsterdam Growth Study
Cardiovascular risk factors in
childhood carry over to adulthood
• Blood pressure and other cardiovascular risk
factors were measured in 1500 boys and girls
ranging age from 5-14 years and again 15 years
later. Over 18% of the adults who were in the
highest quintile of blood pressure as children
developed essential hypertension as opposed to
5% in the lower quintiles
– Bao W, Threefoot SR, Strinivasen SR, Berenson GS. Essential hypertension
predicted by tracking of elevated blood pressure from childhood to adulthood:
The Bogalusa Heart Study. Amer J Hypertension 1995, 8(7), 1-8
– Twisk J Tracking of blood cholesterol over a 15 year peiod and its relation to
other risk factors for coronary heart disease. Den Haag, NL: CIP-Data Koninklijk
Bibliotheek, 1995
Activity(Weighted Mets) and VO2
max in childhood and young
adulthood
6000
5000
Mets
4000
Hi VO2 M
Lo VO2 M
Hi VO2 F
Lo VO2 F
3000
2000
1000
0
13
15
21
13
15
21
Age in Years
Data from Fig. 12:Kemper HCG,The Amsterdam Growth and Health Longitudinal Study
Normal FEV1 changes in adulthood
• A longitudinal study of normal changes in VO2
Max showed that the decline in VO2 max follows
a constant percentile. If you were in the 80th
percentile of your height group at age 50, you
would be in the 80th percentile when you were
70 even though the VO2 value would be be
lower at age 70
– Pearson JD, Kao SY, Brant LJ, Metter EJ, Fozard JL. Longitudinal changes in
forced expiratory volume in healthy, nonsmoking men and women: The Baltimore
Longitudinal Study of Aging. Am J Human Biol., 1998,10,471-481.
Rapid change in FEV1 in adulthood
is an independent risk factor for
cardiac death
• The rate of change in FEV1 over many biannual
observations was estimated for each of over 800 male
participants in the Baltimore Longitudinal Study of Aging
who were free of pulmonary and cardiovascular disease
at time of first measurement.
• The rates of change were used in a risk factor analysis
• The major result was that the odds ratios for cardiac
death increased with higher rates of decline in both
smokers and nonsmokers
– Tockman MS, Pearson JD, Metter EJ, Kao SY Rampal KG,
Cruise LF, Fozard JL. Rapid decline in FEV1: A new risk factor
for coronary heart disease mortality. J Resp. Critical Care Med.,
1995,151,390-398
Extended Health requires us to
change how we think about aging
• Negative stereotypes about old age and
aging are detrimental to the well being and
personal fulfillment of young and old alike
• Agism is apparent in many jokes:
– Pervasive negative stereotypes about aging
– Poor parental training about aging to the
young
– Poor appreciation of individual differences
Let’s change our way of thinking
about aging
• Pervasive negative stereotypes about
aging
– If I knew I was going to live this long, I would
have taken better care of myself
– One senior to another: “When does old age
begin?” Answer: “Later”
– Young adult’s most serious life decision?
Answer: “ When to begin middle age”
Let’s change our way of thinking
about aging
• Poor parental training of the young about
aging
– Dennis the Menace to his father’s friend:
“What age are you in the middle of?”
– Child to grandmother: “If I’m only young once,
how many times do I have to be old?”
Let’s change our way of thinking
about aging
• Poor appreciation of individual differences
– Old man answers question about his age: “What age
do you mean--My anatomical, physiological,
psychological, or chronological?
– This gentleman is both smart and wise, smart
because of the critical distinctions and wise because
chronological age is at the end of the list
• When asked what his doctor thought about his
lifestyle choices at age 100+, George Burns
replied, “I don’t know, my doctor’s dead.”
Technology can help education and
training activities related to aging
• Simulations can help educate people for
aging in various situations (BJ Fogg)
– Cause and effect simulations (social skills)
– Environmental simulations (treat phobias)
– Object simulations (drunk driver)
• Simulations of aging for young people can
reduce negative attitudes toward aging
Virtual simulations of aging and
healthy lifestyles
• Since the 1970s, many simulations of age
related sensory and mobility limitations have
been devised to educate the young
– Clouded lenses, ear plugs, gloves, weighted shoes
etc.
– Limitation is lack of linkage of these devices and
preventive and compensatory interventions
• Virtual reality simulations can improve
education by linking simulations of limitations
to effects of compensatory and preventive
measures
Old Adults perform ADLs closer to
max strength than young adults
Hortobagyi T, Mizelle C, Beam S,
DaVita P. J. Gerontology:Medical
Sciences, 2003, 58A,453-460.
Purpose/Methods
• Walking, going up and down stairs and rising from chair
requires relatively higher percentage of maximum
reserve capacity in older than younger adults--True for
cardiovascular and muscle function
• Study measured relative effort to perform these tasks by
assessing maximal leg strength on a machine and by the
force used when going up or down stairs or standing up
from a chair. Force was measured by special recording
plate embedded in the floor or steps
• Participants were healthy women in two age groups
mean ages 22 and 74 years.
Relative effort (%) of maximum
strength required to perform ADLs
TASK
AGE
Ascending
Stairs
Descending Rising from
Stairs
Chair
22
55
35
35
74
80
88
80
Long-Term Consequences of
Age Differences in Strength
• Midlife strength predicts functioning 25 years
later
• Grip strength measured at age 45 to 68 in
Japanese-American men. 25 years later speed
of walking, ability to stand up from chair, and
self-reports of difficulty lifting 10 lbs, doing
housework, etc were measured.
•
Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of
old age disability JAMA 1999;281:558-560
% with Limitations in Strength
Groups Measured 25 Yrs Ago
30
25
20
% 15
low 3rd
mid 3rd
high 3rd
10
5
0
House wk
10 steps
slow walk chair rise
Difficulty with Function
Data from Rantanen et al, JAMA 1999;281:559
Effects of strength training on
mobility—basic findings
• Strength training and physical activity
improve muscle mass, control of
movement, and balance
•
•
•
•
Fiaterone MA, Marks EC, Ryan ND et al. High-intensity strength training in
nonogernians:Effects of skeletal muscle. J Am Med Ass, 1990;263:3029.
Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM, Metter EJ, Fozard JL,
Hurley BH. The effects of strength training and detraining on muscle quality
: Age and gender comparisons J Gerontol:Biol Sci 2000;55A:B152-B157.
Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR, Ettinger WH Physical
activity, funtional limitations and disability in older adults J Am Ger Soc
2000;48:1264-1272.
Since 2000, dozens of well designed studies extend these early
studies e.g., J. Gerontology: Med Sci 2007;62A;(June);2007; 62A(Aug)
Young Men
Young Women
Older Men
OlderWomen
Muscle Quality(MQ) is strength/volume. Strength training of
right leg occurred over 9 months; detraining over 31 weeks.
From Ivey et al 2000
Strength and Gait Speed
• Leg exension strength and leg power correlate
with gait speed. The distributions of leg power
associated with different speeds may provide the
basis for setting goals for strength needed for
walking.
•
Rantanen T, Avela J Leg extension power and walking speed in very old people
living independently. J Gerontol Med Sci 1997;52A:M225-M331.
• Correlations between power and speed ranged
from .4 to.7 in old people
•
Kwon I, Oldaker S, Schrager MA, Talbot LA, Fozard JL, Metter EJ. Relationship
between muscle strength and self-paced gait speed: Age and sex effects. J
Gerontol Biol Sci 2001;56B:B398-B404
Cumulative
distributions of
leg power for 5
groups of walking
speed from <1m/s
to>2m/s
Cum
%
Data from
Rantanen
andAvela 1997
Leg power is expressed as Watts/kg
Note that the cumulative % of leg power at 1m/s ranged from 1-3 W/kg
The cumulative % of leg power at 2m/s ranged from 8-15.5 W/kg
Technology and setting goals for
strength training
• Prevention requires that we set standards for
reserve strength needed for adequate
functioning at a later age
• Early estimates--we need 40% of our strength at
age 25 to function well at age70
• Wearable transducers provide information on
quality and required number of maneuvers
– New technology development at University of Pisa by
Dr. E. Piaggio allows for Kinesthetic sensing by use of
smart fabrics in gloves, socks and leotards
– http://www.piaggio.ccii.unipi.it/kine.htm
Networking improves coaching
in strength training
• Motivation is major issue for utilizing
strength training—machines can have
motivational properties
• Networking can improve motivation
and quality of feedback from strength
training
– Reinforcement from sharing information by peers
doing similar workouts
Technology and motivation:
Computerized coaching
• FitLinxx is a computerized system that attaches directly
to existing fitness equipment
– FitLinxx “learns” users' programs, “coaches” them individually
through their workout for better form, safety and confidence
during every exercise, and “tracks” their progress over time.
• On strength equipment, FitLinxx appears as an easy-toread touch-screen display that's attached to the
machine. For cardiovascular equipment, each machine's
existing console is simply networked to FitLinxx
– Users simply tap in their PIN to display their targets - FitLinxx
then coaches them on speed, form, heart rate, etc., and tracks
the workout session - every rep, set and step.
• http://www.fitlinxx.com/Article.htm?ID=976